Endoscopic retrograde direct cholangioscopy combined with endoscopic papillectomy in treatment of duodenal papillary adenoma

Given the high risk of malignant transformation in duodenal papillary adenomas, timely endoscopic resection is critical [1] [2]. The conventional procedure involves snare resection followed by placement of biliary and pancreatic duct stents under fluoroscopic guidance to ensure drainage. However, conventional radiographic methods cannot assess invasion at the terminal ends of the biliary and pancreatic ducts, and in some cases, cannulation of these ducts may fail. To address these issues during endoscopic procedures, we apply endoscopic retrograde direct cholangioscopy (ERDC) [3] [4], a technique that we developed to allow complete visual resection of duodenal papillary adenomas without fluoroscopic assistance.